System and method for data driven risk relationship review tool

ABSTRACT

A system to provide an automated data driven risk relationship review tool via a back-end application computer server of an enterprise. A resource allocation data store may contain electronic records representing requested resource allocations between the enterprise and a plurality of entities. The server may receive an indication of a selected requested resource allocation and retrieve, from the resource allocation data store, the electronic record associated with the selected requested resource allocation. The server may automatically calculate a first and second review date for the selected requested resource allocation and automatically establish, between at least two parties, a communication link based on the calculation of the first review date for the selected requested resource allocation. The system may then support a graphical interactive user interface display via a distributed communication network, the interactive user interface display providing resource allocation data in connection with the second review date.

CROSS REFERENCE TO RELATED APPLICATION

This is a continuation of U.S. patent application Ser. No. 17/900,016,entitled “SYSTEM AND METHOD FOR DATA DRIVEN RISK RELATIONSHIP REVIEWTOOL,” filed Aug. 31, 2022, which is a continuation of U.S. patentapplication Ser. No. 16/837,413, entitled “SYSTEM AND METHOD FOR DATADRIVEN RISK RELATIONSHIP REVIEW TOOL,” filed Apr. 1, 2020, the entirecontents of which are incorporated herein by reference for all purposes.

BACKGROUND

It may be advantageous to analyze the risks and resource allocationsassociated with multiple systems and/or entities. For example, it mightbe advantageous to understand particular amounts of risk and allocationsand the impact that such risks and allocations may have had on past(and, potentially, future) performance. Moreover, an enterprise mightwant to facilitate understanding and reaction to requests forallocations of resources—and a manual review of such requests may be animportant part of this process.

In some cases, a report may be manually created and given to aninsurance agent/broker and/or customer to help them understand the risksituation. For example, FIGS. 1A and 1B show an example of a typicalreport that may be used to review claim information with an insuranceagent/broker or customer. In particular, FIG. 1A shows a first page 110of typical claim status report that might be used to explain and/orreview a workers' compensation claim. The report might be generated, forexample, using a spreadsheet application such as the EXCEL® spreadsheetapplication available from MICROSOFT®. The first page 110 might include,for example, insured information 112 (e.g., of a business that purchasedworkers' compensation insurance from an insurer). The first page 110might further include claim information 114, such as an employee name,claim number, date of hire, date of loss, occupation, location of loss,employment status, wage data, demographic information, attorneyinformation, etc. The first page 110 might also include financialinformation 116, such as paid, outstanding, and/incurred monetary valuesfor indemnity, medial, and expense costs. The first page 110 could alsoinclude claim professional information 118 (e.g., a name and contactinformation) and additional data (e.g., text notes describing the loss,providing a current medical status, a disability status, and mitigatingfactors). FIG. 1B shows a second page 120 of typical claim status reportthat might be used to explain and/or review a workers' compensationclaim, including a reserve rationale 122 and a resolution plan 124.

Similarly, FIGS. 2A and 2B show another example of a typical report thatmay be used to review claim information with an insurance agent/brokeror customer. As before, FIG. 2A shows a first page 210 of typical claimstatus report that might be used to explain and/or review a workers'compensation claim. The first page 210 again includes insuredinformation 212, claim information 214, financial information 216, claimprofessional information 218, and additional data. FIG. 2B shows asecond page 220 of typical claim status report that might be used toexplain and/or review a workers' compensation claim, including a reserverationale 222 and a resolution plan 224.

The breadth and depth of information associated with resource requests,often over an extended period of time, can overwhelm such a reviewprocess. That is, manually collecting, formatting, examining, andunderstanding these types of risks and allocations associated with riskrelationships can be a complicated, time consuming, and error-pronetask, especially when there are a substantial number of inter-relatedsystems, entities, characteristics impacting resource allocations,and/or other factors involved in the analysis. Moreover, manuallydetermining who should receive the report (and how and when they need toreceive them) can be a difficult task for a claim handler, claim accountexecutive, workforce manager, team leader, etc.

It would be desirable to provide systems and methods to display anautomated data driven risk relationship review tool in a way thatprovides more accurate results, which are easier to communicate in atimely fashion as compared to traditional approaches.

SUMMARY OF THE INVENTION

According to some embodiments, systems, methods, apparatus, and computerprogram code display an automated data driven risk relationship reviewtool in a way that provides more accurate results, which are easier tocommunicate in a timely fashion as compared to traditional approachesand that allow for flexibility and effectiveness when providing thoseresults. In some embodiments, a system may provide an automated datadriven risk relationship review tool via a back-end application computerserver of an enterprise. The system may include a resource allocationdata store that contains electronic records representing requestedresource allocations between the enterprise and a plurality of entities.The server may receive an indication of a selected requested resourceallocation and retrieve, from the resource allocation data store, theelectronic record associated with the selected requested resourceallocation. The server may automatically calculate a first and secondreview date for the selected requested resource allocation andautomatically establish a communication link based on the first reviewdate for the selected requested resource allocation. The system may thensupport a graphical interactive user interface display via a distributedcommunication network, the interactive user interface display providingresource allocation data in connection with the second review date.

Some embodiments comprise: means for receiving, by a computer processorof a back-end application computer server from a resource allocationdata store, an indication of a selected requested resource allocationbetween an enterprise and an entity, wherein the resource allocationdata store contains electronic records that represent a plurality ofrequested resource allocations between the enterprise and a plurality ofentities, and further wherein each electronic record includes anelectronic record identifier and a set of resource allocation valuesassociated with risk attributes; means for retrieving, from the resourceallocation data store, the electronic record associated with theselected requested resource allocation, including the set of resourceallocation values associated with risk attributes; means forautomatically calculating a first and second review date for theselected requested resource allocation; and means for automaticallyestablishing a communication link based on the first review date for theselected requested resource allocation, wherein the back-end applicationcomputer server supports a graphical interactive user interface displayvia a distributed communication network, the interactive user interfacedisplay providing resource allocation data in connection with the secondreview date.

In some embodiments, a communication device associated with a back-endapplication computer server exchanges information with remote devices inconnection with an interactive graphical user interface. The informationmay be exchanged, for example, via public and/or proprietarycommunication networks.

A technical effect of some embodiments of the invention is an improvedand computerized way to display an automated data driven riskrelationship review tool in a way that provides more accurate results,which are easier to communicate in a timely fashion as compared totraditional approaches. With these and other advantages and featuresthat will become hereinafter apparent, a more complete understanding ofthe nature of the invention can be obtained by referring to thefollowing detailed description and to the drawings appended hereto.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B show an example of a typical report that is used toreview claim information with an insurance agent/broker or customer.

FIGS. 2A and 2B show another example of a typical report that is used toreview claim information with an insurance agent/broker or customer.

FIG. 3 is a high-level block diagram of a system architecture inaccordance with some embodiments.

FIG. 4 illustrates a method according to some embodiments of the presentinvention.

FIGS. 5A through 5C show a claim review process in accordance with someembodiments.

FIG. 6 is a more detailed block diagram of a system architectureaccording to some embodiments.

FIGS. 7A and 7B show an example of a claim review display in accordancewith some embodiments.

FIGS. 8A and 8B show another example of a claim review display inaccordance with some embodiments.

FIG. 9 illustrates an interactive claim review display according to someembodiments.

FIG. 10 illustrates a method according to some embodiments of thepresent invention.

FIG. 11 is a block diagram of an apparatus in accordance with someembodiments of the present invention.

FIG. 12 is a portion of a tabular resource allocation database accordingto some embodiments.

FIG. 13 illustrates a tablet computer displaying a data driven riskrelationship review tool user interface according to some embodiments.

FIG. 14 illustrates an overall process in accordance with someembodiments.

DETAILED DESCRIPTION

The present invention provides significant technical improvements tofacilitate electronic messaging and dynamic data processing. The presentinvention is directed to more than merely a computer implementation of aroutine or conventional activity previously known in the industry as itsignificantly advances the technical efficiency, access, and/or accuracyof communications between devices by implementing a specific new methodand system as defined herein. The present invention is a specificadvancement in the area of electronic risk analysis and/or resourceallocation by providing benefits in data accuracy, data availability,and data integrity and such advances are not merely a longstandingcommercial practice. The present invention provides improvement beyond amere generic computer implementation as it involves the processing andconversion of significant amounts of data in a new beneficial manner aswell as the interaction of a variety of specialized client and/orthird-party systems, networks, and subsystems. For example, in thepresent invention information may be processed, updated, and analyzedvia a back-end-end application server to accurately improve the analysisof risk, the allocation of resources, and the automated exchange ofinformation in a timely fashion, thus improving the overall efficiencyof the system associated with message storage requirements and/orbandwidth considerations (e.g., by reducing the number of messages thatneed to be transmitted via a network). Moreover, embodiments associatedwith collecting accurate information might further improve risk values,predictions of risk values, allocations of resources, electronic recordrouting, etc.

FIG. 3 is a high-level block diagram of a system 300 according to someembodiments of the present invention. In particular, the system 300includes a back-end application computer 350 server that may accessinformation in a resource allocation data store 310 (e.g., storing a setof electronic records representing requests for an allocation ofresources, each record including, for example, one or more requestedresource allocation identifiers, attribute variables, resource values,communication addresses, etc.). The back-end application computer server350 may also retrieve information from other data stores or sources 320,330, 340 in connection with a resource allocation review tool 355 and,in some embodiments, apply machine learning or artificial intelligencealgorithms and/or models to the electronic records. The back-endapplication computer server 350 may also exchange information with aremote device 360 (e.g., via communication port 365 that might include afirewall).

According to some embodiments, an interactive graphical user interfaceplatform of the back-end application computer server 350 (and, in somecases, third-party data) may facilitate the display of informationassociated with the resource allocation review tool 355 via one or moreremote computers (e.g., to enable a manual review of a resourceallocation request) and/or the remote device 360. For example, theremote device 360 may receive updated information (e.g., a new eventtimeline) from the back-end application computer server 350. Based onthe updated information, a user may review the data from the resourceallocation data store 310 and take informed actions in response torequests. For example, a communication link may be automaticallyestablished (e.g., based on a communication address in the resourceallocation data store 310) in connection with an email server, workflow,and/or calendar application 370. The communication link might comprise,for example, an audio link, a text chat link, a video link, etc.

Note that the back-end application computer server 350 and/or any of theother devices and methods described herein might be associated with acloud-based environment and/or a third party, such as a vendor thatperforms a service for an enterprise.

The back-end application computer server 350 and/or the other elementsof the system 300 might be, for example, associated with a PersonalComputer (“PC”), laptop computer, smartphone, an enterprise server, aserver farm, and/or a database or similar storage devices. According tosome embodiments, an “automated” back-end application computer server350 (and/or other elements of the system 300) may facilitate updates ofelectronic records in the resource allocation data store 310. As usedherein, the term “automated” may refer to, for example, actions that canbe performed with little (or no) intervention by a human.

As used herein, devices, including those associated with the back-endapplication computer server 350 and any other device described hereinmay exchange information via any communication network which may be oneor more of a Local Area Network (“LAN”), a Metropolitan Area Network(“MAN”), a Wide Area Network (“WAN”), a proprietary network, a PublicSwitched Telephone Network (“PSTN”), a Wireless Application Protocol(“WAP”) network, a Bluetooth network, a wireless LAN network, and/or anInternet Protocol (“IP”) network such as the Internet, an intranet, oran extranet. Note that any devices described herein may communicate viaone or more such communication networks.

The back-end application computer server 350 may store information intoand/or retrieve information from the resource allocation data store 310.The resource allocation data store 310 might, for example, storeelectronic records representing a plurality of resource allocationrequests, each electronic record having a set of attribute valuesincluding one or more resource values. The resource allocation datastore 310 may also contain information about prior and currentinteractions with entities, including those associated with the remotedevices 360. The resource allocation data store 310 may be locallystored or reside remote from the back-end application computer server350. As will be described further below, the resource allocation datastore 310 may be used by the back-end application computer server 350 inconnection with an interactive user interface to provide informationabout the resource allocation review tool 355. Although a singleback-end application computer server 350 is shown in FIG. 3 , any numberof such devices may be included. Moreover, various devices describedherein might be combined according to embodiments of the presentinvention. For example, in some embodiments, the back-end applicationcomputer server 350 and the resource allocation data store 310 might beco-located and/or may comprise a single apparatus.

According to some embodiments, the system 300 may provide a graphicalview of insurance claim files. This might help, for example, aninsurance agent, broker, or customer quickly determine key claiminformation about an injured worker, insured, and/or treatment provideralong with a risk score that might indicate when an insurance claim isveering “off track” (and might present a risk of a severe outcome for anenterprise).

Note that the system 300 of FIG. 3 is provided only as an example, andembodiments may be associated with additional elements or components.According to some embodiments, the elements of the system 300automatically transmit information associated with an interactive userinterface display over a distributed communication network. FIG. 4illustrates a method 400 that might be performed by some or all of theelements of the system 300 described with respect to FIG. 3 , or anyother system, according to some embodiments of the present invention.The flow charts described herein do not imply a fixed order to thesteps, and embodiments of the present invention may be practiced in anyorder that is practicable. Note that any of the methods described hereinmay be performed by hardware, software, or any combination of theseapproaches. For example, a non-transitory computer-readable storagemedium may store thereon instructions that when executed by a machineresult in performance according to any of the embodiments describedherein.

At S410, a back-end application computer server (e.g., associated withan enterprise) may receive an indication of a requested resourceallocation between the enterprise and an entity. For example, anoperator or administrator associated with the enterprise might select aresource allocation request from a list of pending resource allocationrequests. According to some embodiments, the operator may search forrequests based on an entity name, a request type, a date associated withthe request, etc. At S420, the back-end application computer server mayretrieve, from a resource allocation data store, an electronic recordassociated with the selected requested resource allocation, includingthe set of resource allocation values associated with risk attributes.

At S430, the system may automatically calculate a first and secondreview date for the selected requested resource allocation. The firstreview date might, for example, indicate when a team internal to aninsurance enterprise will review an insurance claim. The second reviewdate might, according to some embodiments, indicate when the insuranceenterprise will use claim review displays to explain an insurance claimsituation to an insurance agent, broker, and/or customer.

At S440, the system may automatically establish a communication linkbased on the first review date for the selected requested resourceallocation. This link might be used, for example, to internally (withinan insurer) review and/or discuss claim information with a claimhandler, claim account executive, workforce manager, team leader, etc.Note that the back-end application computer server may support agraphical interactive user interface display via a distributedcommunication network, and the interactive user interface display mayprovide resource allocation data (external to the insurer) in connectionwith the second review date. According to some embodiments, thecalculation of the first and/or second review dates may be associatedwith a predictive model created using data fields and text flagsidentified in electronic records of the resource allocation data store,claim data, bill data from a bill review system, etc. Moreover, the userinterface may further provide a view of claim factors that drawattention to the request if there is a potential of increasing severity.

In this way, embodiments may leverage insights from multiple machinelearning assets and claim metrics to give a holistic view of the claimin one place. Moreover, risks of certain aspects of a claim may becalculated by the system which can then provide a “next best action” toa claim handler. In addition, the data visualization of claim activityand risk factors may enable quick orientation to the claim and providesa direction where a claim handler's attention should be focused (and, insome embodiments, a next best action). Further note that embodiments mayprovide information to help claim handlers determine an appropriateresponse (without automatically making any claim decisions).

FIGS. 5A through 5C show a claim review process 500 that may beperformed by a claim account executive, claim workforce manager (“WFM”),claim handler, and/or team leader in accordance with some embodiments.The process 500 might be performed, for example, quarterly, bi-annually,etc. At 502, the claim account executive may identify an agreed uponneed for a claim file review and initiate a request that such a reviewbe conducted. At 504, the claim account executive may pull a list ofclaims and initiate a formal request to the workforce manager foroptimal review dates at 506.

At 508, the workforce manager may assess and provide primary andalternative dates to the claims account executive. At 510, the claimaccount executive may issue alternative dates and/or confirm dates andfile listing with an insurance agent, broker, and/or customer at 512.This process may continue until the case account executive notifies theworkforce manager of a requested date at 514 and alerts attendees bysending a calendar and/or meeting invitation at 516.

At 518, the claim handler is notified of the date and claim and willensure that the claim files are updated and complete (e.g., 10 daysbefore a claim review meeting). Similarly, at 520 the team leader mayreview and confirm that the claims are ready for review. At 522, theworkforce manager may confirm that the reports are ready to publishand/or provides any required edits to the claim handler. This processmay be repeated until the workforce manager indicates that the report isready, causing the claims account manager to pull the reports for allidentified insurance claims at 524. At 528, the workforce manager mayoptionally (as illustrated by the dashed line in FIG. 5B) decide if aformal preparation session is required. If so, at 530 the claim handlerwill review the claim. If not (or after the claim handler reviews theclaim), at 532 the claim account executive may issue the report to theinsurance broker, agent, and/or client (e.g., 5 days before a claimreview meeting).

At 534, the claim account executive may facilitate the claim reviewmeeting with the insurance broker, agent, and/or client and the claimhandler may deliver the file review at 536 in accordance with any of theembodiments described herein (e.g., as described with respect to FIGS.7A through 8B). Optionally, the team leader might attend the session toobserve the claim handler at 538. The claim account executive may thencapture the meeting summary and any action items arising from the reviewsession at 540 (e.g., 2 days after the claim review meeting).

At 542, the claim account executive may share action items with theworkforce manager and/or feedback with the team leader as appropriate(e.g., 10 days after the claim review meeting). The workforce managermay review. At 544, the workforce manager may review the action itemsand the team leader may review the feedback and confirm the action planat 546. At 548, the claim handler may update the file and execute theaction items (e.g., 30 days after the claim review meeting). At 550, theteam leader may validate completion and the workforce manager may manageany required follow-up at 552. At 554, the workforce manager may confirmthat all action items have been completed and the claim accountexecutive may confirm that all open items are complete at 556.

FIG. 6 is a more detailed high-level block diagram of a system 600 inaccordance with some embodiments. As before, the system 600 includes aback-end application computer 650 server that may access information ina historic claim data store 610 (storing electronic data recordsassociated with insurance claims 612, including a claim identifier 614,a date of loss 616, an injury type 618, a communication address, etc.)and transmit displays to a claim handler device 660 (e.g., vie afirewall 665). In this example, a claim review tool 655 may receiveinformation from one or more bill data systems 620, third-party datasystems 630, a predictive model 640, etc. The predictive model 640might, according to some embodiments, use data fields and text flagsidentified in files automatically calculate review dates. The claimanalysis tool 655 might also access insurance claim data to drawinformation that is available to the claim handler in their claim system(and, in some cases, data that is not visible to the claim handlers inthe claim system). According to some embodiments, the claim analysistool might use bill data 620 from a bill review system (e.g., associatedwith medical treatments from health care providers). The third-partydata 630 might originate from medical providers or police reports. Theback-end application computer server 650 might also transmit informationdirectly to an email server, workflow application, calendar application670 to facilitate insurance claim processing (e.g., to automaticallyschedule meetings, establish communication links, etc.).

FIGS. 7A and 7B show an example of a claim review display in accordancewith some embodiments. In particular, this display is associated withthe example of FIGS. 1A and 1B. FIG. 7A shows a first page 710 of thedisplay according to some embodiments including high level icons (e.g.,loss year, attorney representation, etc.), a graphical representation ofthe claimant's body 712 highlighting injuries, demographic information714, claim reserve data 716, a claim reserve rationale description 718,etc. In some embodiments, the page 710 might provide a claim detail dataheader in the demographic information 714 (e.g., including a date ofloss, a compensability status, an open time status, a claimant age, anda claimant gender) and/or an insured detail data header (e.g., includingan insured name, a claim program, and a re-assignment count). The bodydiagrams 712 (e.g., front and back views) may provide a graphicalrepresentation of injuries including a visual indication of claim orinjury status (e.g., associated with claim status, injury description,diagnosis and recover information). According to some embodiments,selection of an injury (e.g., via touchscreen or a computer mousepoints) might result in a pop-up window providing additional information(e.g., an indication that the injury is under investigation, is beingtreated, etc.). In some embodiments, the page 710, along with the otherdisplays described herein, give a claim handler a high-level, holisticview that aggregates data from various disparate sources in connectionwith a single workers' compensation insurance claim. Such a view mayhelp the insurer explain the claim to an insurance agent, broker, and/orcustomer in a more efficient and accurate manner.

According to some embodiments, the page 710 further includes resourceallocation bar graphs in the reserves area 716 (e.g., associated withvarious costs including a total cost) and/or information about the lastpayment to the claimant (e.g., associated with a payment type, a status,a payment date, and a link to further payment details). The page 710 mayfurther include an overall score (e.g., associated with how likely theclaim is to dramatically change) and with prior claim information (e.g.,associated with other claims by the same claimant). A set of dialdisplays (e.g., associated with various claim factors) might indicate toa claim handler whether various entities are relatively low-risk,relatively high-risk, etc. Such a claim (or “resource request”) healthindex information might provide the claim handler with a view of theclaim factors that draw his or her attention to the claim. The dialdisplays may be related to various actors associated with the claim. Ifthere is a potential of the claim increasing in severity (or it isidentified that the insured is not happy with the progress of theclaim), the claim handler may be alerted to that fact via theappropriate dial display.

According to some embodiments, the page 710 might further includemap-based geographic information and/or event timeline informationassociated with a claim. For example, the page 710 might include a“back” icon (left arrow) and “forward” icon (right arrow), and selectionof the forward icon might result in the display of a second page 720 asillustrated in FIG. 7B. The second page 720 might include timelineinformation 822 showing major event throughout the history of the claim(e.g., date of loss, surgery, date of return to work, payments,treatments, etc.) and/or a resolution plan 824.

FIGS. 8A and 8B show another example of a claim review display inaccordance with some embodiments. In this case, the display isassociated with the example of FIGS. 2A and 2B. As before, a first page810 of the display includes high level icons, a graphical representationof the claimant's body 812 highlighting injuries, demographicinformation 814, claim reserve data 816, a claim reserve rationaledescription 818, etc. FIG. 8B shows a second page 820 of the display,including timeline information 822 and/or a resolution plan 824.

FIG. 9 illustrates an “interactive” claim review display 900 accordingto some embodiments. In this case, selection or “roll-over” of agraphical element of the display 900 (e.g., via a computer mouse pointer910 or touchscreen) results in the display of a popup window 920 thatshows additional details about that element. According to someembodiments, such a popup window 920 might be utilized to adjust oralter information (e.g., a user might enter a new “End Date” via thepopup window 920).

FIG. 10 illustrates a method 1000 according to some embodiments of thepresent invention. At S1010, a back-end application computer server(e.g., associated with an insurer) may receive an indication of aninsurance claim between the insurer and a claimant. For example, a claimhandler might select an insurance claim from a list of pending insuranceclaims. At S1020, the back-end application computer server may retrieve,from an insurance claim data store, an electronic record associated withthe selected insurance claim, including a claim identifier, date ofinjury, type of injury, communication address, etc.

At S1030, the system may automatically calculate a first and secondreview date for the selected insurance claim. The first review datemight, for example, indicate when a team internal to an insuranceenterprise will review the selected insurance claim. The second reviewdate might, according to some embodiments, indicate when the insuranceenterprise will use claim review displays to explain an insurance claimsituation to an insurance agent, broker, and/or customer.

At S1040, the system may automatically establish a communication linkbased on the first review date for the selected insurance claim. Thislink might be used, for example, to internally (within an insurer)review and/or discuss claim information with a claim handler, claimaccount executive, workforce manager, team leader, etc. Note that theback-end application computer server may support a graphical interactiveuser interface display via a distributed communication network, and theinteractive user interface display may provide insurance claim data(external to the insurer) in connection with the second review date.According to some embodiments, the calculation of the first and/orsecond review dates may be associated with a predictive model createdusing data fields and text flags identified in electronic records of aninsurance claim data store, claim data, bill data from a bill reviewsystem, etc.

The embodiments described herein may be implemented using any number ofdifferent hardware configurations. For example, FIG. 11 illustrates anapparatus 1100 that may be, for example, associated with the systems300, 600 described with respect to FIGS. 3 and 6 , respectively. Theapparatus 1100 comprises a processor 1110, such as one or morecommercially available Central Processing Units (“CPUs”) in the form ofone-chip microprocessors, coupled to a communication device 1120configured to communicate via communication network (not shown in FIG.11 ). The communication device 1120 may be used to communicate, forexample, with one or more remote administrator computers and orcommunication devices (e.g., PCs and smartphones). Note thatcommunications exchanged via the communication device 1120 may utilizesecurity features, such as those between a public internet user and aninternal network of the insurance enterprise. The security featuresmight be associated with, for example, web servers, firewalls, and/orPCI infrastructure. The apparatus 1100 further includes an input device1140 (e.g., a mouse and/or keyboard to enter information about aninsured, injuries, claim negotiations, etc.) and an output device 1150(e.g., to output review displays regarding insurance claim status).

The processor 1110 also communicates with a storage device 1130. Thestorage device 1130 may comprise any appropriate information storagedevice, including combinations of magnetic storage devices (e.g., a harddisk drive), optical storage devices, mobile telephones, and/orsemiconductor memory devices. The storage device 1130 stores a program1115 and/or a resource allocation tool or application for controllingthe processor 1110. The processor 1110 performs instructions of theprogram 1115, and thereby operates in accordance with any of theembodiments described herein. For example, the processor 1110 mayprovide an automated data driven risk relationship review tool. Aresource allocation data store may contain electronic recordsrepresenting requested resource allocations between the enterprise and aplurality of entities. The processor 1110 may receive an indication of aselected requested resource allocation and retrieve, from the resourceallocation data store, the electronic record associated with theselected requested resource allocation. The processor 1110 mayautomatically calculate a first and second review date for the selectedrequested resource allocation and automatically establish acommunication link based on the first review date for the selectedrequested resource allocation. The processor 1110 may then support agraphical interactive user interface display via a distributedcommunication network, the interactive user interface display providingresource allocation data in connection with the second review date.

The program 1115 may be stored in a compressed, uncompiled and/orencrypted format. The program 1115 may furthermore include other programelements, such as an operating system, a database management system,and/or device drivers used by the processor 1110 to interface withperipheral devices.

As used herein, information may be “received” by or “transmitted” to,for example: (i) the back-end application computer server 1100 fromanother device; or (ii) a software application or module within theback-end application computer server 1100 from another softwareapplication, module, or any other source.

In some embodiments (such as shown in FIG. 11 ), the storage device 1130further stores an existing risk relationship database 1160 (e.g.,containing insurance policy information), an insurance claim database1200, an underwriting database 1170, and a third-party database 1180. Anexample of a database that might be used in connection with theapparatus 1100 will now be described in detail with respect to FIG. 12 .Note that the database described herein is only an example, andadditional and/or different information may be stored therein. Moreover,various databases might be split or combined in accordance with any ofthe embodiments described herein. For example, the existing riskrelationship database 1160 and the insurance claim database 1200 mightbe combined and/or linked to each other within the program 1115.

Referring to FIG. 12 , a table is shown that represents the insuranceclaim database 1200 that may be stored at the apparatus 1200 accordingto some embodiments. The table may include, for example, entriesassociated with insurance claims that have been submitted by claimants.The table may also define fields 1202, 1204, 1206, 1208, 1210 for eachof the entries. The fields 1202, 1204, 1206, 1208, 1210 may, accordingto some embodiments, specify: an insurance claim identifier 1202, aninsured name 1204, an insurance policy identifier 1206, review dates1208, and a status 1210. The insurance claim database 1200 may becreated and updated, for example, based on information electricallyreceived from various operators, administrators, and computer systems,including those associated with an insurer.

The insurance claim identifier 1202 may be, for example, a uniquealphanumeric code identifying a request for resources (e.g., when anemployee working for an insured becomes injured while at work). Theinsured name 1204 might be associated with the owner of insurance policyassociated with the identifier 1206. The review dates 1208 might beautomatically calculated by the system and be associated with aninternal insurer claim review, an external explanation about the claim,an automatically established communication link, etc. Note that thedatabase 1200 will include additional information about each insuranceclaim (not illustrated in FIG. 12 ), such as claim handler notes,medical treatment costs, legal negotiations, etc. The status 1210 mightindicate that the insurance claim is closed, pending review, in process,denied, etc.

Thus, embodiments may be associated with an automated and efficient wayto display a data driven risk relationship review tool in a way thatprovides more accurate results, which are easier to communicate in atimely fashion as compared to traditional approaches. Embodiments mayaggregate data from multiple sources and use machine learning algorithmsto help claim handlers quickly recognize which claims might need closerattention. By digesting information, such as medical records, andapplying artificial intelligence, embodiments may leverage availabledata and automate medical treatment judgements, help motivate andinfluence claimant behavior, etc. The displays may provide a “360”degree view of a claim or customer including aggregated data from manydifferent sources. For example, a claim handler might quickly understandtwo years of complex claim processing with such an end-to-end view ofthe data. Note that the data used to render the displays describedherein might include data from unstructured sources, such as paragraphsof text from manually created notes, governmental or medical documents,phone call transcripts, etc.

The following illustrates various additional embodiments of theinvention. These do not constitute a definition of all possibleembodiments, and those skilled in the art will understand that thepresent invention is applicable to many other embodiments. Further,although the following embodiments are briefly described for clarity,those skilled in the art will understand how to make any changes, ifnecessary, to the above-described apparatus and methods to accommodatethese and other embodiments and applications.

Although specific hardware and data configurations have been describedherein, note that any number of other configurations may be provided inaccordance with embodiments of the present invention (e.g., some of theinformation associated with the displays described herein might beimplemented as a virtual or augmented reality display and/or thedatabases described herein may be combined or stored in externalsystems). Moreover, although embodiments have been described withrespect to particular types of insurance policies, embodiments mayinstead be associated with other types of insurance policies in additionto and/or instead of the policies described herein (e.g., professionalliability insurance policies, extreme weather insurance policies, etc.).Similarly, although certain attributes (e.g., values analyzed inconnection with resource allocation requests) were described inconnection with some embodiments herein, other types of attributes mightbe used instead.

Further, the displays and devices illustrated herein are only providedas examples, and embodiments may be associated with any other types ofuser interfaces. For example, FIG. 13 illustrates a handheld tabletcomputer 1300 showing a data driven risk relationship review tooldisplay 1310 according to some embodiments. The resource allocation tooldisplay 1310 might include user-selectable data that can be selectedand/or modified by a user of the handheld computer 1310 to provideinsurance claim review information to insurance agents/brokers and/orcustomers.

Note that the displays described herein might be constantly updatedbased on new information (e.g., as data is received by the insurer). Forexample, the displays might be updated in substantially real time or ona periodic basis (e.g., once each night). According to some embodiments,a claim handler might be able to select a particular time in the pastand the displays may be updated to reflect the information as itpreviously existed at that particular time (e.g., what would the claimhandler have seen one year ago?).

FIG. 14 illustrates an overall business process 1400 in accordance withsome embodiments. At S1410, an insurer may receive a new insurance claimfrom a claimant. This information may be collected from various sources,including medical records, an incident report, etc. At S1420, the systemmay automatically calculate a first and second review date for theinsurance claim. The first review date might, for example, indicate whena team internal to an insurance enterprise will review the insuranceclaim. The second review date might, according to some embodiments,indicate when the insurance enterprise will use claim review displays toexplain an insurance claim situation to an insurance agent, broker,and/or customer.

At S1430, the system may automatically establish a communication linkbased on the first review date for the insurance claim. This link mightbe used, for example, to internally (within an insurer) review and/ordiscuss claim information with a claim handler, claim account executive,workforce manager, team leader, etc. At S1440, claim informationdisplays are provided to an insurance agent/broker and/or customer aspart of a review process (e.g., as described in connection with FIGS. 7Athrough 8B) on the second review date. The insurer may then process theinsurance claim as directed by the claim handler, agent/broker, and/orcustomer (e.g., by approving medical procedures or otherwiserecommending a medical treatment, implementing a return-to-workstrategy, etc.) at S1450.

The present invention has been described in terms of several embodimentssolely for the purpose of illustration. Persons skilled in the art willrecognize from this description that the invention is not limited to theembodiments described, but may be practiced with modifications andalterations limited only by the spirit and scope of the appended claims.

What is claimed:
 1. A system to provide a data driven risk relationshipreview tool via a back-end application computer server of an enterprise,comprising: (a) a plurality of remote devices; (b) an email server,workflow application, and calendar application to automatically schedulemeetings and establish communication links; (c) the back-end applicationcomputer server, coupled to the plurality of remote devices, the emailserver, workflow application, calendar application, and resourceallocation data store, including: a computer processor, and a computermemory, coupled to the computer processor, storing instructions that,when executed by the computer processor, cause the back-end applicationcomputer server to: (i) receive, from a first remote device of theplurality of remote devices, a request for a resource allocation betweenthe enterprise and an entity, the request including data from athird-party data source; (ii) automatically calculate a first and secondreview date for the requested resource allocation, and (iv)automatically establish a communication link as one of an audio link, atext chat link, and a video link and schedule a meeting for the firstreview date, via the email server, workflow application, and calendarapplication, based on the calculation of the first review date for therequested resource allocation, wherein the communication link isestablished between at least two parties; and (d) a communication portcoupled to the back-end application computer server to transmit data tothe first remote device to support a graphical interactive userinterface display via a distributed communication network, theinteractive user interface display providing resource allocation data inconnection with the second review date.
 2. The system of claim 1,wherein calculation of the first and second review dates are associatedwith at least one of: a predictive model created using data fields andtext flags identified in electronic records of the resource allocationdata store, claim data, and bill data from a bill review system.
 3. Thesystem of claim 1, wherein the communication link is further associatedwith at least one of: (i) a calendar application, and (ii) an emailmessage.
 4. The system of claim 1, wherein the user interface furtherprovides a view of claim factors that draw attention to the request ifthere is a potential of increasing severity.
 5. The system of claim 1,wherein the user interface further provides at least one of: (i)demographic information, (ii) graphical indications of body locations,(iii) resource allocation reserve information, (iv) a resourceallocation reserve rationale, (v) time information, and (vi) a resourceallocation resolution plan.
 6. The system of claim 1, wherein the userinterface leverages insights from multiple machine learning assets andclaim metrics.
 7. The system of claim 1, wherein risks of certainaspects of a claim are calculated by the system and used to provide anext best action to a claim handler.
 8. A computerized method to providea data driven risk relationship review tool via a back-end applicationcomputer server of an enterprise, comprising: receiving, by a computerprocessor of the back-end application computer server from a firstremote device of a plurality of remote devices, a request for a resourceallocation between the enterprise and an entity, the request includingdata from a third-party data source; automatically calculating a firstand second review date for the requested resource allocation; andautomatically establishing a communication link as one of an audio link,a text chat link, and a video link and schedule a meeting for the firstreview date, via an email server, workflow application, and calendarapplication, based on the calculation of the first review data for therequested resource allocation, wherein the communication link isestablished between at least two parties and wherein the back-endapplication computer server transmits data to the first remote device insupport of a graphical interactive user interface display via adistributed communication network, the interactive user interfacedisplay providing resource allocation data in connection with the secondreview date.
 9. The method of claim 8, wherein calculation of the firstand second review dates are associated with at least one of: apredictive model created using data fields and text flags identified inelectronic records of a resource allocation data store, claim data, andbill data from a bill review system.
 10. The method of claim 8, whereinthe communication link is further associated with at least one of: (i) acalendar application, and (ii) an email message, (iii) an audio link.11. The method of claim 8, wherein the user interface further provides aview of claim factors that draw attention to the request if there is apotential of increasing severity.
 12. The method of claim 8, wherein theuser interface further provides at least one of: (i) demographicinformation, (ii) graphical indications of body locations, (iii)resource allocation reserve information, (iv) a resource allocationreserve rationale, (v) time information, and (vi) a resource allocationresolution plan.
 13. The method of claim 8, wherein the user interfaceleverages insights from multiple machine learning assets and claimmetrics.
 14. The method of claim 8, wherein risks of certain aspects ofa claim are calculated and used to provide a next best action to a claimhandler.
 15. A non-transitory, computer-readable medium storinginstructions, that, when executed by a processor, cause the processor toperform a method to provide a data driven risk relationship review toolvia a back-end application computer server of an enterprise, the methodcomprising: receiving, by the computer processor of the back-endapplication computer server from a first remote device of a plurality ofremote devices, a request for a resource allocation between theenterprise and an entity, the request including data from a third-party;automatically calculating a first and second review date for therequested resource allocation; and automatically establishing acommunication link as one of an audio link, a text chat link, and avideo link and scheduling a meeting for the first review date, via anemail server, workflow application, and calendar application, based onthe calculation of the first review date for the requested resourceallocation, wherein the communication link is established between atleast two parties, and wherein the back-end application computer servertransmits data to the first remote device in support of a graphicalinteractive user interface display via a distributed communicationnetwork, the interactive user interface display providing resourceallocation data in connection with the second review date.
 16. Themedium of claim 15, wherein calculation of the first and second reviewdates are associated with at least one of: a predictive model createdusing data fields and text flags identified in electronic records of theresource allocation data store, claim data, and bill data from a billreview system.
 17. The method of claim 15, wherein the user interfacefurther provides a view of claim factors that draw attention to therequest if there is a potential of increasing severity.
 18. The mediumof claim 15, wherein the user interface further provides at least oneof: (i) demographic information, (ii) graphical indications of bodylocations, (iii) resource allocation reserve information, (iv) aresource allocation reserve rationale, (v) time information, and (vi) aresource allocation resolution plan.
 19. The medium of claim 15, whereinthe user interface leverages insights from multiple machine learningassets and claim metrics.
 20. The medium of claim 15, wherein risks ofcertain aspects of a claim are calculated and used to provide a nextbest action to a claim handler.